The board found that Smith's decision to continue flying in the poor conditions resulted in the crash in a remote, wooded area in Clay County, killing all three men on board.
Smith did not make any backup plans for the organ transport. Other SK Logistic pilots told investigators that they would have made the same flight but would have arranged for ground transportation or a flight by a fixed-wing aircraft if they could not complete the mission as scheduled, according to the report.
"Contributing to the pilot's improper decision was his self-induced pressure to complete the trip," according to the report.
The helicopter had some equipment for navigation in bad weather, but it wasn't certified to do so by the Federal Aviation Administration, said Bob Gretz, the senior NTSB investigator handling the crash.
"It was like pockets of good and bad weather all along the route," Gretz said. "The board, they're really not faulting him for initiating the flight. They're faulting him for continuing in bad weather."
Smith's business had faltered in the recession, and the Mayo Clinic had begun looking at other companies to fly medical transport missions. The hospital's preferred helicopter — the only one operated by SK Logistics that was certified to fly under instrument flight rules necessitated by the bad weather — had been grounded for four months while the company attempted to secure loans for engine maintenance, according to the NTSB report.
"Thus, the pilot would have been highly motivated to complete trips as requested so that he could demonstrate the reliability of his service," the board said.
Smith was a decorated veteran of combat missions in Vietnam and routinely flew medical transport flights for the company he founded in 1997, his son has said. In bankruptcy proceedings after the crash, SK Logistics listed $1.3 million in assets and more than $8.9 million in debt.
"Hoke continued to operate the company, however, and continued to put over $1 million of his own funds into the company because he had such a passion for flying and for his missions of delivering organs to patients. The accident was a real tragedy and the family was devastated," said Nina LaFleur, the attorney who represented SK Logistics in the bankruptcy proceedings.
The crash also killed heart surgeon Dr. Luis Bonilla and procurement technician David Hines.
"We will always remember the selfless and intense dedication they brought each day to making a difference in the lives of our patients," said Dr. William Rupp, CEO of the Mayo Clinic in Florida. He deferred questions about the report to the NTSB.
In response to a question from the Associated Press about Smith's lack of a backup plan for his flight, the Mayo Clinic said in a statement: "The industry standard is for the hospital to defer to its commercial flight contractor on decisions to fly, type of aircraft, and the necessity for any backup plan. Mayo Clinic adheres to this standard. In this situation, we understand the commercial flight contractor did not put in place a backup plan because they felt that the weather was conducive to flight."
No flight plan was filed for the helicopter, and Smith's last contact with the air traffic control tower at Jacksonville International Airport was routine, according to the report. There was no evidence in the wreckage of any in-flight fire or mechanical or structural malfunction before the crash, and Smith never made a distress call.
A former pilot for the company told investigators that the area where Smith crashed was susceptible to fog due to swampy terrain and turned into a "black hole" at altitudes of 200 to 400 feet, the board said.
Weather conditions in Jacksonville and Gainesville were safe, but Smith's actions showed that conditions in between were variable, said Robert Spohrer, the attorney representing Hines' family.
"He was flying at different altitudes and at different routes in an effort to stay legal or in visual meteorological conditions. We know from the circumstances of the crash that he couldn't do that," Spohrer said.